Community pharmacies, as a key interface between the health-care system and the general public, have the potential to substantially reduce the prevalence of tobacco use-particularly among key population groups for which tobacco use is a major risk factor for development or exacerbation of diseases requiring prescription medications. While the busy community pharmacy environment is not typically conducive to comprehensive tobacco cessation counseling, it might be ideal for widespread implementation of brief interventions, such as asking about tobacco use, advising patients to quit, and referring patients to toll-free tobacco quitlines. In the proposed study, we will expand upon our ongoing collaboration with the UCSF Smoking Cessation Leadership Center and will team with Free &Clear, a nationally recognized provider of telephone-based counseling services. We propose a randomized trial to estimate the impact of two intervention approaches for generating pharmacy-based referrals to tobacco quitlines: MINIMAL INTERVENTION: pharmacies are provided, by mail, with printed quitline materials to be distributed by pharmacy personnel to patients who smoke, and ACADEMIC DETAILING: pharmacy personnel receive, via brief on-site training, print materials that parallel the minimal intervention group and DVD demonstrations that model the referral procedures. Community pharmacies in Connecticut (n=24) and Washington (n=24) will comprise the study population. Intervention impact will be assessed through measures of (a) the number of quitline referral cards provided to patients, (b) the number of incoming calls to the quitline originating from each participating pharmacy, and (c) the number of quitline counseling registrants that originate from each pharmacy. In addition, we will conduct a longitudinal survey of pharmacists and pharmacy clerks/technicians at each site, to assess self-reported tobacco cessation counseling and patient referral behavior and to identify factors associated with self-reported quitline referral practices. The Ask-Advise-Refer model to be advocated in this community-based intervention study is a feasible approach for integration into routine pharmacy practice. Nationwide, more than 50,000 community pharmacies employ approximately 144,000 pharmacists. If each pharmacist were to refer just one patient per week to a quitline, this would result in nearly 7.5 million referrals annually. PUBLIC HEALTH RELEVANCE: Community pharmacies, as a key interface between the health-care system and the general public, have the potential to substantially reduce the prevalence of tobacco use-particularly among key population groups for which tobacco use is a major risk factor for development or exacerbation of diseases requiring prescription medications (e.g., cardiovascular disease, pulmonary disease, and diabetes). The proposed project will evaluate an intervention to promote pharmacy-based referrals to tobacco quitlines, thereby engaging the pharmacy profession in taking a more active role toward reducing the prevalence of tobacco use in the United States.